Health and social care Multi-Disciplinary Teams: will Integrated Care Systems encourage them to come together or play apart?
Robin Miller, Agato Pacho and Garry Brough
- National Voices’ Conference on ICSs
- Integrated care
- Primary care
MDTs in primary care
As part of an evaluation of the Integrated Care and Support Pioneers, the researchers interviewed staff working in community-based MDTs with caseloads of people aged 55 and over living with long-term health conditions.
One of the main functions of those MDTs was to support GPs with resources to respond to people with complex and multiple needs. Emerging findings suggest that interviewees saw integrated working as beneficial to them and the patients. The added value of having MDTs was felt despite the barriers to integration, such as lack of long-term funding, IT inter-operability issues and absence of shared patient records. More joined-up care also meant an increased knowledge and understanding of local services and other professionals’ roles and capacities.
MDTs were seen as creating an opportunity to work creatively as a group to provide more holistic care to patients, for example through improved access to voluntary services and community resources. Yet, the reported obstacles faced by the MDTs continue to put their benefits at risk. Changing availability of MDT members and insufficient local capacity and service availability were particularly challenging.
MDTs and HIV
HIV clinicians have long prioritised person-centred care. To build on this, the Fast Track Cities Initiative (FTCI) London funded three Improvement Collaborative projects to explore how to improve the integration of peer support workers into the existing clinical MDT. The peer support workers aim to provide support for people living with HIV who may experience a range of non-medical challenges (such as HIV-related stigma, poverty, migration issues) which make it difficult for them to remain engaged with their care and treatment.
Given that the reasons for disengaging from care and treatment tend to be psychosocial, the peer support workers (through an honorary contract with the clinic) can provide lived experience of managing the challenges of HIV. They can also navigate patients to external support services to enhance mental, social, and emotional wellbeing.
MDTs working together
One participant at the ICS event reported that her son, who has complex needs, accesses support from several MDTs. She described their interaction as being like children playing in pre-school – whilst they were occupying a similar place, they had no interaction with each other! This appeared to be due the MDTs effectively understanding their individual roles and how their members could work together, whilst struggling to determine how they interact with other teams. Another participant shared that whilst decisions made by the MDT were sound, a lack of timely communication about what decisions were made and when resulted in considerable anxiety for the person and their family.
Practice and research evidence confirms that MDTs can help to bring together professionals to better co-ordinate care around people and families and provide more holistic support by providing a route for the voluntary sector to contribute. Lived experience highlights though that MDTs need to maintain their focus on communicating with people and families and taking time to understand the range of issues they face and related support. A major role for ICS’s will be to ensure the benefits of MDTs are realised by ensuring that the local workforce, digital and financial environments can facilitate collaboration within and between MDTs.
Disclaimer: The Pioneer programme evaluation is an independent evaluation funded by the National Institute for Health Research (NIHR) Policy Research Programme ‘Evaluation of the Integrated Care and Support Pioneers Programme in the context of new funding arrangements for integrated care in England’, PR-R10-1014-25001. The views expressed are those of the authors and are not necessarily those of the NIHR or the Department of Health and Social Care.
Robin Miller is the Professor of Collaborative Learning in Health and Social Care at the University of Birmingham. His research interests include integration, leadership, and implementation of new ways of working together and he edits the International Journal of Integrated Care.
Agata Pacho is a Research Fellow in the Policy Innovation and Evaluation Research Unit (PIRU) at the London School of Hygiene & Tropical Medicine. She holds a PhD in Sociology from Goldsmiths, University of London. Her research interests include integration of care, health services, diagnostics, antimicrobial resistance, sexual health and HIV.
Garry Brough: Diagnosed HIV+ in 1991, Garry has worked to increase access to peer support in both the NHS and voluntary sector. He currently works for Positively UK, as Lead for Peer Learning, Partnerships and Policy, and manages their peer support integration project within Chelsea & Westminster’s four London HIV clinics.